Korean Journal of Nephrology 2009;28(4):310-316.
Acute Graft Pyelonephritis after Kidney Transplantation: Clinical Manifestations and the Impact on Long-term Allograft Outcome
Yu-Ji Lee, M.D.1, Na Ree Kang, M.D.2, Jung Eun Lee, M.D.1, Wooseong Huh, M.D.1, Sung-Joo Kim, M.D.3, Yoon-Goo Kim, M.D.1, Dae Joong Kim, M.D.1 and Ha Young Oh, M.D.1
Department of Medicine1
and Department of Surgery3
Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul Department of Internal Medicine2
Seoul Medical Center, Seoul, Korea
임상연구 : Acute Graft Pyelonephritis after Kidney Transplantation: Clinical Manifestations and the Impact on Long-term Allograft Outcome
Yu-Ji Lee, M.D.1, Na Ree Kang, M.D.2, Jung Eun Lee, M.D.1, Wooseong Huh, M.D.1, Sung-Joo Kim, M.D.3, Yoon-Goo Kim, M.D.1, Dae Joong Kim, M.D.1 and Ha Young Oh, M.D.1
Department of Medicine1, and Department of Surgery3, Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul Department of Internal Medicine2, Seoul Medical Center, Seoul, Korea
Abstract
Purpose:The objective of this study was to investigate the clinical manifestations and risk factors associated with acute graft pyelonephritis (AGPN) and its impact on graft outcome. Methods:We performed a retrospective study reviewing the medical records of 272 recipients with a graft survival of more than 1 year among 291 recipients that had undergone kidney transplantation between January 1995 and December 1999. Results:Twenty eight (10.3%) patients had at least one episode of AGPN during a follow-up of 7.3 years, and 14 (50%) among them had recurrent episodes. 31.5% of total AGPN episodes had no any urinary signs and symptoms and only had a fever and leukocyturia. Escherichia coli and Klebsiella, the most common pathogens isolated, were susceptible to ciprofloxacin in 48.6% of cases and to ceftriaxone in 94.3% of cases. Acute rejection was not associated with the occurrence of AGPN. However, female gender was a risk factor for acute rejection (risk ratio 7.11, p<0.001). Vesicoureteral reflux in allograft was found in 72.7% of the recipients with an episode of AGPN (16/22). There was a trend toward more frequent development of vesicoureteral reflux in recipients with recurrent AGPN episodes (54.6% in patients with a single episode vs 90.9% in patients with recurrent episodes, p= 0.074). On Cox regression/Time-dependent covariate analysis, AGPN had no significant association with the graft or patient survival. Conclusion:AGPN is common after kidney transplantation, especially in women. However, AGPN was not associated with a poor long-term graft outcome.
Key Words: Kidney transplantation, Pyelonephritis, Graft survival, Risk factors
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